Time since HIV diagnosis is linked to amnestic mild cognitive impairment (MCI) in older adults with HIV

Aging people with HIV (PWH) may be at heightened risk of Mild Cognitive Impairment (MCI), including the subtypes amnestic MCI (aMCI) and non-amnestic MCI (naMCI). We examined associations between putative risk factors (HIV clinical variables, lifetime substance exposure, APOE genotype) and clinician consensus-defined MCI status in older PWH. Additionally, we evaluated agreement between clinician consensus aMCI and algorithmic (Jak-Bondi) aMCI classification, as well as overlap between aMCI and HIV-Associated Neurocognitive Disorder (HAND). PWH (N = 56; median age 63; IQR 61-67) completed a neurocognitive battery. Two neuropsychologists assigned consensus diagnoses (aMCI/naMCI/no MCI). Alcohol, cocaine, opioid, and cannabis exposure, years since HIV diagnosis, and time from diagnosis to care were assessed by self-report. APOE was genotyped from whole blood. HIV viral load (detectable/undetectable) was assayed from plasma. Algorithmic aMCI classification was made using modified Jak-Bondi criteria and HAND classification using Frascati criteria. 36% of participants (N = 20) met consensus aMCI criteria. aMCI status was significantly associated with years since HIV diagnosis, time to care, and opioid exposure in age-adjusted models. However, MCI status was not associated with alcohol, cocaine, or cannabis exposure, APOE genotype, or detectable viral load. Agreement between clinician consensus and algorithmic aMCI classification was substantial. Participants with aMCI and naMCI (vs. no MCI) were significantly more likely to meet HAND criteria. Because time since diagnosis and time from diagnosis to care were associated with amnestic MCI in PWH, greater cumulative HIV exposure may be linked to greater neuropathology in aging.